Impact of the COVID-19 Epidemic on Patients with Myeloproliferative Neoplasia: The French Prospective Observational Study Covim

Methods. The aim of the observational COVIM study was to assess the rate of severe COVID-19 infection in subgroups of French patients with MPN during the pandemic. To this avail, it included all consecutive patients from 21 French centers seen in consultation or teleconsultation between May 12, 2020, and may 31, 2021. Information was collected about MPN characteristics and treatment as well as the occurrence, management and outcome of COVID-19 infection and follow-up. The study has been registered on ClinicalTrial.gov (NCT 04416438).

Results. A total of 1793 consecutive patients (47% males) was included. The median age at inclusion was 67 yo (IQR 56-75). MPN subtypes were 37% PV, 45% ET and 18% MF. MPN driver mutations were 78% JAK2V617F, 14% CALR and 3% MPL while 5% of the patients had no driver mutation detected. The most frequent MPN treatments were hydroxyurea (HU) or pipobroman (51%), interferon (IFN) (19%), ruxolitinib (12%) and anagrelide (3%) alone or in combination; 15% of the patients did not receive cytoreductive therapy. The majority of patients (80%) received antiplatelet therapy as thrombosis prevention.

A total of 295 episodes of COVID-19 infection were identified in 287 patients, documented in 196 cases by SARS-Cov-2 PCR and/or serology and by clinical history or CT scan for the remaining cases. Seven episodes were asymptomatic, 6 associated with thrombosis (4 pulmonary embolisms, 1 splanchnic, 1 stroke) and 27 with acute respiratory failure. Hospitalization was required for 63 patients (only conventional n= 38, intensive care unit n=25). Cytoreductive treatment was maintained in 88% of the cases, discontinued in 12% and decreased in 1 patient respectively. At last follow-up, 20 patients with COVID-19 had died, as a consequence of the infection for 15 and of MPN (acute transformation) in 3 (2 unknown causes). This yields a global COVID-19 related death rate of 5,2% in these 287 patients. Comparison between the MPN population with and without a COVID infection showed that older age and arterial hypertension were significant risk factors. In contrast, treatment with IFN was associated with less severe forms of COVID-19, the median age of these patients being however younger.

Conclusions. This large observational and prospective cohort of patients with MPN demonstrated a rate of COVID-19 infection of 16%. Among patients with COVID-19, 22% required hospitalization. These rates indicate that the pandemic did not so dramatically affect this specific population of patients, with an overall COVID-related mortality 0.8%. Two hypotheses could be raised for this low rate of infection. One is that MPNs do not constitute an additional risk factor for SARS-CoV-2 infection. On the other hand, patients with MPN may have applied very strictly preventive measures as they were informed of a potentially higher risk in patients with hematological malignancies.